Clinical Xenotransplantation: A Suggested Next Step

Recent progress has been made toward introducing gene-edited (GE) pig heart and kidney xenotransplantation into clinical practice. In particular, the outcomes of GE pig kidney transplantation have been promising, with three recipients currently surviving between 3 and 9 months after transplantation. These encouraging results highlight the growing feasibility of xenotransplantation as a solution to the shortage of human donor organs. In the United States and many other countries, nearly half of all patients on kidney transplant waiting lists are diabetic. Individuals with diabetic nephropathy often achieve better outcomes when they receive both kidney and islet allotransplants, as this combination restores renal function and improves glucose control. Therefore, such patients would be ideal candidates for combined GE pig kidney and islet xenotransplantation. Because immunosuppressive therapy is essential to maintain a kidney graft, performing a simultaneous islet transplant is clinically justifiable. Studies in nonhuman primates have demonstrated that porcine islet transplantation can achieve long-term glucose regulation, supporting its translational potential. For the foreseeable future, until complications such as post-transplant proteinuria are fully resolved, we propose that patients with diabetic nephropathy receive a human kidney allotransplant in combination with a GE pig islet xenotransplant to optimize outcomes and improve long-term metabolic stability.